<%@ page language="java" contentType="text/html; charset=ISO-8859-1"
	pageEncoding="ISO-8859-1"%>
<%@taglib prefix="s" uri="/struts-tags"%>
<!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN" "http://www.w3.org/TR/html4/loose.dtd">

<s:if test="hasActionErrors()">
	<s:include value="messages.jsp">
		<s:param name="errorMsg">
			<s:actionerror />
		</s:param>
	</s:include>
</s:if>
<!-- <s:if test="hasActionMessages()">
   <div class="welcome">
      <s:actionmessage/>
   </div>
</s:if> 
 -->

<s:form id="ContactForm" cssStyle="padding-left:50px">
	<h2 class="pad_bot1">Information Form</h2>
	<table>

		<tr>
			<td class="tdRight"><s:label
					value="%{getText('docHunt.doctorInfo.name')}" /></td>
			<td>
				<table cellpadding="0" cellspacing="0">
					<tr>
						<td>
							<s:textfield name="doctorDTO.firstName" id="firstNameTxt"
								grey-vlaue="First Name" cssClass="smallInput">
							</s:textfield>
						</td>
						<td width="10px"></td>
						<td>
							<s:textfield name="doctorDTO.middleName" id="middleNameTxt" 
								grey-vlaue="Middle Name" cssClass="smallInput">
							</s:textfield>
						</td>
						<td width="10px"></td>
						<td>
							<s:textfield name="doctorDTO.lastName" 	id="lastNameTxt" 
								grey-vlaue="Last Name" cssClass="smallInput">
							</s:textfield>
						</td>
					</tr>
				</table>
			</td>
		</tr>
		
		<tr>
			<td colspan="2">
				<table cellpadding="0" cellspacing="0">
					<tr>
						<td class="tdRight"><s:label for="emailTxt"
							value="%{getText('docHunt.doctorInfo.email')}" />
						</td>
						
						<td><s:textfield name="doctorDTO.email" id="emailTxt"
							grey-vlaue="Type Your E-mail Here" cssClass="input"></s:textfield>
						</td>
						
						<td width="30px"></td>
						
						<td width="200px" rowspan="4" align="center">
						<div style="border: 1px solid #DFD9C3; width: 180px; height: 130px"></div>
						</td>
					</tr>
					
					<tr>
						<td class="tdRight"><s:label for="mobileNoTxt"
							value="%{getText('docHunt.doctorInfo.mobileNo')}" />
						</td>
						
						<td><s:textfield name="doctorDTO.mobileNo" id="mobileNoTxt"
							grey-vlaue="Type Your Mobile No. Here" cssClass="input"></s:textfield>
						</td>	
						
						<td colspan="2">
						</td>
					</tr>
					
					<tr>
						<td class="tdRight"><s:label for="genderRadio"
							value="%{getText('docHunt.doctorInfo.gender')}" />
						</td>
						
						<td valign="middle">
							<s:radio name="doctorDTO.gender" id="genderRadio" list="genderList" cssClass="radioInput"></s:radio>
						</td>
						
						<td colspan="2">
						</td>
					</tr>
					
					<tr>
						<td class="tdRight"><s:label for="birthDateTxt"
							value="%{getText('docHunt.doctorInfo.birthDate')}" />
						</td>
						
						<td><s:textfield name="doctorDTO.birthDate" id="birthDateTxt"
							grey-vlaue="Type Your Birth Date Here" cssClass="smallInput"></s:textfield>
						</td>
						
						<td colspan="2"></td>
					</tr>
					
					<tr>
						<td colspan="3">
						</td>
						
						<td align="center"><button type="button" value="Register" class="button">Upload Photo</button>
						</td>
					</tr>
				</table>
			</td>
		</tr>

		<tr>
			<td class="tdRight"><s:label for="addressTxt"
					value="%{getText('docHunt.doctorInfo.address')}" /></td>
			<td><s:textfield name="doctorDTO.address" id="addressTxt"
					grey-vlaue="Type Your Address Here" cssClass="input"></s:textfield>
			</td>
		</tr>

		<tr>
			<td class="tdRight"><s:label for="areaTxt"
					value="%{getText('docHunt.doctorInfo.area')}" /></td>
			<td><s:textfield name="doctorDTO.area" id="areaTxt"
					grey-vlaue="Type Your Area Here" cssClass="input"></s:textfield></td>
		</tr>

		<tr>
			<td class="tdRight"><s:label for="pinCodeTxt"
					value="%{getText('docHunt.doctorInfo.pinCode')}" /></td>
			<td><s:textfield name="doctorDTO.pinCode" id="pinCodeTxt"
					grey-vlaue="Type Your Pin Code Here" cssClass="input"></s:textfield>
			</td>
		</tr>

		<tr>
			<td class="tdRight"><s:label for="cityTxt"
					value="%{getText('docHunt.doctorInfo.city')}" /></td>
			<td><s:textfield name="doctorDTO.city" id="cityTxt"
					grey-vlaue="Type Your City Here" cssClass="input"></s:textfield></td>
		</tr>


		<tr>
			<td class="tdRight"><s:label for="contactNoTxt"
					value="%{getText('docHunt.doctorInfo.contactNo')}" /></td>
			<td><s:textfield name="doctorDTO.contactNo" id="contactNoTxt"
					grey-vlaue="Type Your Contact No. Here" cssClass="input"></s:textfield>
			</td>
		</tr>

		<tr>
			<td class="tdRight"><s:label for="photoTxt"
					value="%{getText('docHunt.doctorInfo.photo')}" /></td>
			<td><s:textfield name="doctorDTO.photo" id="photoTxt"
					grey-vlaue="Attach Photo Here" cssClass="input"></s:textfield></td>
		</tr>

		<tr>
			<td class="tdRight"><s:label for="otherInfoTxt"
					value="%{getText('docHunt.doctorInfo.otherInfo')}" /></td>
			<td><s:textfield name="doctorDTO.otherInfo" id="otherInfoTxt"
					grey-vlaue="Type Other Information Here" cssClass="input"></s:textfield>
			</td>
		</tr>

		<tr>
			<td><br /></td>
		</tr>
		<tr>
			<td colspan="2" align="center">
				<button type="button" value="Register" class="button"
					onclick="formSubmit(this.value,this.form,'doctorInfoSubmit.action');">Register</button>
				&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
				<button type="button" value="Cancel" class="button">Cancel</button>
			</td>
		</tr>
		<tr>
			<td><br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />
				<br /> <br /></td>
		</tr>
	</table>
</s:form>
<script type="text/javascript">
	applyStyle();

	
</script>